Provider Demographics
NPI:1093181646
Name:BAY AREA SURGICAL SPECIALISTS, INC. A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:BAY AREA SURGICAL SPECIALISTS, INC. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:INEZ
Authorized Official - Middle Name:
Authorized Official - Last Name:WONDEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-948-8143
Mailing Address - Street 1:2637 SHADELANDS DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2512
Mailing Address - Country:US
Mailing Address - Phone:925-932-6330
Mailing Address - Fax:925-215-4540
Practice Address - Street 1:19842 LAKE CHABOT RD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4002
Practice Address - Country:US
Practice Address - Phone:510-886-8844
Practice Address - Fax:510-886-2936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-18
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG061064207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1477520096OtherINDIVIDUAL NPI
7360010004OtherNSC MEDICARE